POS0203 PREDICTIVE SEVERITY FACTORS OF COVID-19 IN PATIENTS WITH RHEUMATIC IMMUNE MEDIATED DISEASES
Authors: D. Martínez-López, I. Ferraz-Amaro, D. Prieto-Peña, F. Benavides-Villanueva, C. Corrales-Selaya, L. Sanchez-Bilbao, A. Herrero-Morant, C. Álvarez-Reguera, M. Trigueros-Vazquez, M. A. González-Gay, R. Blanco
Journal: Annals of the Rheumatic Diseases (2022)

Background COVID-19 has become a common disease in patients with rheumatic immune-mediated diseases (R-IMID). A risk stratification of the patients at COVID-19 onset is important to predict possible unfavorable results. Objectives To identify predictive severity factors in patients with COVID-19 with R-IMID. Methods Cross-sectional study in a single University Hospital. We included all consecutive patients with a R-IMID and COVID-19 up to November 6th, 2020. Confirmed infection was defined if the patient had a positive nasopharyngeal swab for SARS-CoV-2. COVID-19 case severity was divided into mild, moderate, severe and critical according to the United States National Institute of Health (NIH) COVID-19 guidelines (1). We performed a multivariable analysis and calculated de odds ratio of critical COVID in patients with R-IMID, adjusting by age, sex and comorbidities. Results We included 274 patients with R-IMID complicated with COVID-19. At COVID-19 onset, the main comorbidities, analytical values, underlying R-IMID and treatments received are shown in Table 1. Table 1. General features patients with R-IMID and COVID-19 General features Overall patients (n=274) Critical COVID (n=21) General features (continuation) Patients (n=274) Critical COVID (n=21) Age, years 59 ±18 76.32 ± 13.4 Analytical values, mean ± SD Female, n (%) 185 (67) 11 (52.4) -CRP (mg/dl) 4.7 ± 5.25 11.7 ± 8.6 CV risk factors, n (% ) -Creatinine (mg/dl) 0.91 ± 0.4 1.4 ± 0.7 -Current smoker 27 (10) 2 (9.5) -Platelets (x103/ul) 179 ± 78 163 ± 72 -Obesity 49 (18) 5 (23.8) -Hemoglobina (g/l) 13.0 ± 1.8 12.5 ± 2.1 -Hypertension 119 (43) 18 (85.7) -Neutrophils (x103/ul) 4.5 ± 2.5 4.9 ± 3.2 -Diabetes Mellitus 36 (13) 5 (23.8) -Lymphocytes (x103/ul) 1.1 ± 1 0.7 ± 0.5 -Dyslipidemia 119 (43) 15 (71.4) -Ferritin (ug/L) 426 ± 417 664 ± 469 Comorbidities, n (% ) -LDH (U/L) 257 ± 92 314 ± 143 -Chronic pulmonary disease 12 (4.4) 3 (14.3) -D-Dimer (ng/ml) 999±1256 1890 ± 1893 -Established cardiovascular disease 45 (16.4) 10 (47.6) Underlying R-IMID, n (% ) -Cancer 21 (8) 6 (28.6) -RA 79 (28.8) 9 (42.9) -Chronic kidney disease 27 (10) 6 (28.6) -PsA 55 (20.1) 3 (14.3) -Chronic liver disease 11 (4) 3 (14.3) -SpA 34 (12.4) 0 Treatments received, n (% ) -PMR 22 (8) 6 (28.6) -Methotrexate // Hydroxychloroquine 62 (23) // 50 (18) 3 (14.3) // 2 (9.5) -SLE 22 (8) 0 -TNFi 31 (11.3) 0 -Vasculitis 8 (2.9) 1 (4.8) -Anti-CD20 8 (2.9) 3 (14.3) -Sjogren’s syndrome 8 (2.9) 2 (9.5) -Other biologic DMARDs // JAKINIBs 16 (5.8) // 6 (2.2) 1 (4.8) // (4.8) -Others 46 (16.8) 0 CRP: C-reactive protein; ILD: Interstitial lung disease; LDH: Lactate dehydrogenase; PMR: Polymyalgia rheumatica¸PsA: Psoriatic arthritis, RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus; SpA: Axial spondyloarthritis *Adjusted by age, cardiovascular risk factors and comorbidities According to COVID-19 severity, patients were mild (n=209; 76.3%), moderate (n=35; 12.8%), severe (n=9; 3.3%) and critical (n=21; 7.7%). The predictive variables at COVID-19 onset related statistically to critical COVID were older patients, hypertension, dyslipidemia, previous cardiovascular disease, cancer, chronic kidney disease, and chronic liver disease. The only underlying R-IMID and treatment was polymyalgia rheumatica and Rituximab, respectively. Regarding analytical values were higher values of C-reactive protein, LDH, platelets and lymphopenia (Figure 1). Figure 1. Predictive factors for critical COVID-19 in R-IMID (Multivariable analysis) COPD: Chronic obstructive pulmonary disease; CRP: C-reactive protein; CV: Cardiovascular; HCQ: Hydroxychloroquine; ILD: Interstitial lung disease; LDH: Lactate dehydrogenase; MTX: Methotrexate; PsA: Psoriatic arthritis; RA: Rheumatoid arthritis; SLE: Systemic lupus erythematosus; TNFi: TNF inhibitors. *p&lt; 0.005 Data in graphic are presented in a logarithmic scale. Conclusion We identified various factors associated with a worse prognosis of COVID-19 in patients with R-IMID. This can help to identify which patients can present a worse course of the disease at the moment of the diagnosis. Disclosure of Interests David Martínez-López: None declared, Iván Ferraz-Amaro: None declared, Diana Prieto-Peña: None declared, Fabricio Benavides-Villanueva: None declared, Cristina Corrales-Selaya: None declared, Lara Sanchez-Bilbao: None declared, Alba Herrero-Morant: None declared, Carmen Álvarez-Reguera: None declared, Martin Trigueros-Vazquez: None declared, Miguel A González-Gay Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Pfizer, Roche, and MSD, Grant/research support from: Dr. Miguel A. Gonzalez-Gay received grants/research supports from Abbvie, MSD, and Roche, Ricardo Blanco Speakers bureau: Consultation fees/participation in company-sponsored speaker´s bureau from Abbvie, Lilly, Pfizer, Roche, Bristol-Myers, Janssen, and MSD., Grant/research support from: Dr. Ricardo Blanco received grants/research supports from Abbvie, MSD, and Roche